A Healthy Diet is Associated with a Lower Risk of Hepatic Fibrosis

Abstract

Background: Higher diet quality is associated with a lower risk of NAFLD.

Objectives: We examined the relationship between diet quality and hepatic fibrosis.

Methods: We analyzed cross-sectional associations between 3 a priori diet quality scores-the Dietary Approaches to Stop Hypertension (DASH) score, the Alternative Healthy Eating Index (AHEI), and a modified Mediterranean-style Diet Score (MDS)-and hepatic fat [controlled attenuation parameter (CAP)] and fibrosis [liver stiffness measurement (LSM)] measured by vibration-controlled transient elastography (VCTE) in 2532 Framingham Heart Study (FHS) participants and 3295 participants of the National Health and Nutrition Examination Survey (NHANES).

Results: Higher diet quality scores were associated with lower LSM in both FHS and NHANES after adjustment for demographic and lifestyle factors. Additional adjustment for CAP or BMI attenuated the observed associations. Association strength was similar across all 3 diet quality scores. Fixed-effect meta-analysis demonstrated that, under CAP-adjusted models, the LSM decreases associated with 1-SD increase of the DASH, AHEI, and MDS scores were 2% (95% CI: 0.7%, 3.3%; P = 0.002), 2% (95% CI: 0.7%, 3.3%; P = 0.003), and 1.7% (95% CI: 0.7%, 2.6%; P = 0.001), respectively, whereas in the meta-analysis of BMI-adjusted models, LSM reductions associated with 1-SD increase of the DASH, AHEI, and MDS scores were 2.2% (95% CI: -0.1%, 2.2%; P = 0.07), 1.5% (95% CI: 0.3%, 2.7%; P = 0.02), and 0.9 (95% CI: -0.1%, 1.9%; P = 0.07), respectively.

Conclusions: We demonstrated associations of higher diet quality with favorable hepatic fat and fibrosis measures. Our data suggest that a healthy diet may reduce the likelihood of obesity and hepatic steatosis as well as the progression of steatosis to fibrosis.

Keywords: DASH score; Framingham Heart Study; NHANES; hepatic fat; hepatic fibrosis; liver fat; nonalcoholic fatty liver disease; vibration-controlled transient elastography.

FIGURE 1

Meta-analysis of FHS and NHANES for association between the diet quality scores and LSM. LSM was log 10 transformed before association analysis. Symbols and bars represent regression coefficients and 95% CIs. The plots in the top panels are data derived from the CAP-adjusted models, and the plots in the bottom panels are data derived from the BMI-adjusted models. Common covariates include sex, age, energy intake, smoking status, alcohol intake, physical activity, and race (in NHANES only). AHEI, Alternative Healthy Eating Index; CAP, controlled attenuation parameter; FHS, Framingham Heart Study; MDS, modified Mediterranean-style Diet Score.

FIGURE 2

Probability of different NAFLD status along with the increase in the DASH score. Plots in the top panel (i.e., A and C) were derived from demographic and lifestyle covariate-adjusted models, i.e., models adjusted for sex, age, energy intake, smoking status, alcohol intake, physical activity, and race (in NHANES only). Plots in the bottom panel (i.e., B and D) were derived from BMI-adjusted models, i.e., models adjusted for the same covariates in demographic and lifestyle covariate-adjusted models and BMI. FHS, Framingham Heart Study; NAFLD, nonalcoholic fatty liver disease.